(2024-04-09) ZviM Medical Roundup2

Zvi Mowshowitz: Medical Roundup #2

Bad News

I know no methodical way to find a good, let alone great, therapist. Cate Hall: One reason it’s so hard to find a good therapist is that all the elite ones market themselves as coaches. As a commentor points out, therapists who can’t make it also market as coaches or similar, so even if Cate’s claim is true then it is tough (mental health)

Good News, Everyone

Bryan Johnson, whose slogan is ‘Don’t Die,’ continues his quest for eternal youth, seen here trying to restore his joints. Mike Solana interviews Bryan Johnson about his efforts here more generally. The plan is to not die via two hours of being studied every day, what he finds is ideal diet, exercise and sleep, and other techniques and therapies including bursts of light and a few supplements.

I wish this man the best of luck. I hope he finds the answers and does not die, and that this helps the rest of us also not die.

Alas, I am not expecting much.

A lot of it seems clearly aimed at being healthy now, feeling and looking younger now. Which is great, but I do not expect it to buy much in the longer term.

I can’t help but notice the parallel to AI safety

Gene therapy cures first case of congenital deafness. Woo-hoo! Imagine what else we could do with gene therapies if we were ‘ethically’ allowed to do so

The Battle of the Bulge

A ‘vaccine-like’ version of Wegovy is on the drawing board at Novo Nordisk (Stat+). If you are convinced you need this permanently it would be a lot cheaper and easier in this form, but this is the kind of thing you want to be able to reverse, especially as technology improves.

We used to eat a lot more, including more starch and sugar, without becoming obese, including people who did limited physical activity

All right, why do the studies find ice cream is good for you, again? As a reminder the Atlantic dug into this a year ago, and now Manifold gives us some options, will resolve by subjective weighing of factors.

My money continues to be on substitution effects, with a side of several of the other things. Ice cream lets you buy joy, and buy having had dessert, at very little cost in calories, nutrition or health. No, it’s not great for you, but it’s not in the same category as other desserts like cake or cookies, and it substitutes for them while reducing caloric intake.

this is one of the easier ways to improve your diet, to substitute ice cream for other desserts.

Support Anti-Aging Research

'‘What we wish we knew entering the aging field.’ I hear optimistic things that we will start to see the first real progress soon, but it is not clear people wouldn’t say those things anyway (life extension)

Periodic Reminders (You Should Know This Already)

Sulfur dioxide in particular is a huge deal. The estimate here is that a 1 ppb drop in levels, a 10% decline in pollution, would increase life expectancy by a whopping 1.2 years. Huge if even partially true, I have not looked into the science

HIPAA in practice is a really dumb law, a relic of a time when digital communications did not exist. The benefits of being able to email and text doctors vastly exceed the costs, and obviously so. Other places like the UK don’t have it and it’s much better

The story of PEPFAR, and how it turned out to be dramatically effective to do HIV treatment instead of HIV prevention, against the advice of economists

FDA Delenda Est

Say it with me, the phrase is catching on, except looks like this was eventually approved anyway? Henry: TIL there was a company that sold a baby sock with an spo2 monitor that sent a push notification if your baby stopped breathing until the FDA forced them to stop selling them because only doctors should be able to see a blood oxygen number. The FDA objection was based on the fact that the wearable had the capacity to relay a live display of a baby’s heart rate and oxygen levels, which is critical data that a doctor should interpret, especially in vulnerable populations.

Other Enemies of Life

Some very silly people argue that it is not preventing schizophrenia unless you do so in a particular individual, if you do it via polygenic selection then it is ‘replacement.’ Scott Alexander does his standard way overthinking it via excruciating detail method of showing why this is rather dumb

90% of junior doctors in South Korea strike to protest against doctors. Specially, against admitting 2,000 more students each year to medical schools (trade guild)

Of all the low hanging fruits in health care, ‘lots of capable people want to be doctors and we should train more of them to be doctors’ has to be the lowest hanging of all.

Covid-19 Postmortems

Vaccine mandates for health care workers worsened worker shortages on net, the ‘I don’t want to get vaccinated or told what to do’ effect was bigger than the ‘I am safer now’ effect, claiming a 6% decline in healthcare employment. Marginal Revolution summarized this as the mandate backfiring. We do see that a cost was paid here. It is not obvious the cost is not worthwhile, and also if someone in healthcare would quit rather than be vaccinated one questions whether you wanted them working that job.

Katelyn Jetelina asks Kelley Krohnert why science lost public trust during the pandemic. The default is still ‘a fair amount’ of trust but the decline is clear especially among Republicans

Here are the core answers given:

Everything sounds like a sales pitch

Data seems crafted to feed the pitch rather than the pitch crafted by data.

*Data mistakes …

Messaging inaccuracies. …

Mixing advocacy with scientific communication*

I would give people more credit. Focusing on what things ‘sound like’ was a lot of what got us into this mess.

The issue wasn’t that everything ‘sounded’ like a sales pitch. The problem was that everything was a sales pitch. (fiat news)

Information that would have been helpful was never provided
Indeed, ‘ethicists’ and other experts worked hard to ensure that we never found out much key information, and that we failed to communicate other highly useful informat we did know or damn well have enough to take a guess about, in ways that ordinary people found infuriating and could not help but notice was intentional.

This has been going on forever in medicine

A disconnect between what I experienced on the ground and the narrative I was hearing

As in, Covid-19 in most cases wasn’t that scary in practice, and people noticed. I do think this one was difficult to handle. You have something that is 95%-99% to be essentially fine (depending on your threshold for fine) but will sometimes kill you. People’s heuristics are not equipped to handle it.

As an example of this all continuing: I have been told that The New York Times fact checks its editorials, and when I wrote an editorial I felt fact checked, but clearly it does not insist on those checks in any meaningful sense, since they published an op-ed claiming the Covid vaccine saved 3 million lives in America in its first two years. That makes zero sense. America has only 331.9 million people, and the IFR for Covid-19 on first infection is well under 1% even for the unvaccinated. The vaccines were amazing and saved a lot of lives. Making grandiose false claims does not help convince people of that.

Covid-19 Origins

Scott Alexander posted an extensive transcript and thoughts on the Rootclaim debate over Covid origins. The natural origin side won decisively, and Scott was convinced

The one note I will make, but hold weakly, is that it seems like people could do a much better job of accounting for correlated errors, model uncertainty or meta uncertainty in their probability calculations.

Assisted Suicide Watch

Rupa Subramanya (The Free Press): Zoraya ter Beek, 28, expects to be euthanized in early May.

She said she was hobbled by her depression and autism and borderline personality disorder. Now she was tired of living—despite, she said, being in love with her boyfriend, a 40-year-old IT programmer, and living in a nice house with their two cats.

She recalled her psychiatrist telling her that they had tried everything, that “there’s nothing more we can do for you. It’s never gonna get any better.”

“I entered the review committee in 2005, and I was there until 2014,” Boer told me. “In those years, I saw the Dutch euthanasia practice evolve from death being a last resort to death being a default option.” He ultimately resigned.

Once again, we seem unable to be able to reach a compromise between ‘this is not allowed’ and ‘this is fully fine and often actively encouraged.’

I am ready to go ahead and say that, if we have to choose one extreme or the other, I choose ‘this is not allowed.’

Ideally I would not go with the extreme. I would instead choose a relatively light ‘this is not allowed’ where in practice we mostly look the other way. But assisting you would still be taking on real legal risk if others decided you did something wrong

Talking Price

New world’s most expensive drug costs $4.25 million dollars. It is a one-off treatment for metachromatic leukodystrophy

this is apparently 1/40,000 US births. Would you pay $100 to guarantee that, if your baby is one of them, they will likely be healthy